Many Upstate residents lack adequate dental coverage

Painful problem: Limited options available

Once a month free tooth extractions are available at Miracle Hill Rescue Mission. Only a limited number of patients can be accommodated, so a line forms early in the morning before the doors open at 8 a.m. Here, volunteer Patricia Morton assists Dr. Brian Armstrong with Ronnie Hutchins in the chair. Dr. Duncan Shirley works on another patient in the background.

Published: Saturday, July 20, 2013 at 3:15 a.m.

Last Modified: Sunday, July 21, 2013 at 1:20 a.m.

She was having toothaches, and without dental insurance, she had limited options for help.

In Spartanburg County, more than 24 percent of working age adults lack health insurance, according to the U.S. Census Bureau. And most health insurance plans don't include dental insurance

On a recent Saturday morning, the Greenville resident sought out one of few available options in the Upstate.

She awoke before sunrise and drove to Miracle Hill Rescue Mission in Spartanburg to see a dentist at a free tooth extraction clinic. She was in line by 4 a.m. and waited four hours outside, hoping someone would relieve the tooth pain that had been nagging her for weeks.

Miracle Hill Rescue Mission holds a free tooth extraction clinic one Saturday a month, starting at 8 a.m. For adults who lack insurance or have a low income, this free clinic is one of only a few options when it comes to dental services, like pulling teeth.

Calvin Vinson, director of Miracle Hill Rescue Mission, says some start lining up as early as 3 a.m.; some even spend the night outside Friday evening. Services are offered on a first-come, first-serve basis, which means some might leave in the afternoon with the same painful ailments they arrive with.

But for Patricia Hunt, who was in line with her father at 7 a.m. — "I thank God a place like this is available," she said.

"I wish there were more of them," she added.

Renee Romberger, vice president of Community Health Policy and Strategy at Spartanburg Regional Healthcare System, said uninsured adults really have nowhere to go for dental help.

They "fall through the cracks," she said.

Poor dental health can lead to a myriad of other health issues and it negatively affects the economy, Romberger says.

Ten percent of adults in Spartanburg County don't have teeth in their mouths, according to data provided by the Road to Better Health Coalition, a group of health leaders committed to improving health in Spartanburg by 2018.

"Folks who have teeth in poor condition have a harder time finding a job and that affects our economy and the health and wellness of our community," she added. "This is a problem that we have to address in Spartanburg. We can't ignore it."

Seeking help

John Daniels, 47, has a different problem.

The Spartanburg resident doesn't need to get a tooth pulled; his problem is trying to get new teeth put in. He needs dentures. But without health insurance or an income, he has no way of getting them.

"I am a diabetic," he said, during a recent phone interview. "I can only eat soft foods because of my teeth."

His diabetes led to him losing some of his teeth, and his lack of teeth exacerbates his diabetes.

"I just wish there was a free dental clinic or somewhere to go," he said.

Harvey Galloway, executive director of BlueCross BlueShield of South Carolina, said Medicaid covers pediatric dental care but adult dental was dropped a few years ago during budget cuts. He said the Affordable Care Act also doesn't cover dental, and many people don't select dental plans because of large deductibles.

Uninsured access to dental care is a problem all counties across the state are facing, Galloway said.

So where do uninsured adults, like Daniels, currently go with dental problems?

Many show up in the emergency room — a place that really can't offer any definitive help.

Research conducted by the American Dental Association Health Policy Resources Center (HPRC) concludes the number of dental emergency room visits in the US jumped from 1.1 million in 2000 to 2.1 million in 2010.

Dr. Chris Lombardozzi, medical director of emergency services at Spartanburg Regional Healthcare System, said patients show up with oral symptoms ranging from local trauma to pain from dental decay or dental abscesses. He said acute infections and pain are typically treated with antibiotics and non-narcotic pain medication. Patients may also receive dental injections for acute relief.

"But for further dental care," Lombardozzi said, "patients with limited financial resources are referred to the ReGenesis Dental Clinic at 550 South Church Street."

ReGenesis Dental Clinic offers services on a sliding pay scale. But people living below the poverty line can't even afford this, said George Newby, director of ReGenesis Health Care.

"If you live below the poverty line and you're an adult, you can't afford dentures or crowns or anything like that. Dentistry is a lot more expensive than medical care."

Volunteer help

Dr. Duncan Shirley, who has a practice in Traveler's Rest, is one of the dentists who volunteers at the free extraction clinic at Miracle Hill Rescue Mission.

"I would say we usually have as many as 70 to 75 (people) out there lined up at one time," he said.

When he is there, he tries to stay until everyone has been seen. But he says a lot of the volunteers, many whom are college dental students, just physically can't. They get tired.

Paul Stevenson, who waited in line on a recent Saturday, said he has come to the clinic in the past, waited in line, and still didn't get seen.

"I just have to come back next month," he said.

Shirley said they generally cut it off at 25 or 30 people, and the people in line understand it's first come, first serve.

Shirley says he has a "real big heart" for helping people, and participating at the clinic is about meeting a mission need here at home, rather than traveling to a foreign country.

"When you finish with someone and they thank you for all that you've done — that makes it all worth it," he said. "I hate turning people away."

Patsy Whitney, director of St. Luke's Free Medical Clinic, said St. Luke's currently provides dental care for its patients on a referral basis. She said 10 dentists currently volunteer to see St. Luke's patients in their offices at no charge.

But that isn't enough, Whitney said.

"Spartanburg is in dire need of free dental care for adults," she said.

Children who come from low-income households can get dental care for free from Healthy Smiles.

Kitta Cates, executive director of Healthy Smiles, said she'd like her program to eventually include something for adults. But the funding has to be present before she can do that.

Newby mentions the idea of offering a quarterly service at ReGenesis Healthcare for these uninsured adults. But again, the matter is funding.

"We are a long way from pulling the trigger on anything," he said.

Search for solutions

While Spartanburg leaders scratch their heads and survey plausible solutions, other counties across the state have already found answers. Galloway says there are 18 free dental clinics scattered throughout South Carolina.

In Horry County, Blue Cross, Blue Shield funded a free dental clinic at Horry-Georgetown Technical College. Volunteer dentists and students in HGTC's dental programs currently treat children and some adults who need limited care at a reduced cost.

"It's a good program and we think it has a lot of potential to replicate in other areas of the state" Galloway said. "But we just awarded that grant so it is just too early to tell."

In Oconee County, Mountain Lakes Access Health program received a $30,000 grant, some of which came from Blue Cross Blue Shield, to help fund a new Community Access Dental Clinic for low-income, uninsured adults.

"We knew access to dental care was one of our greatest needs," said Cortni Nations, executive director of Mountain Lakes Access Health in Seneca. "We decided we needed to do something about the problem,"

So the community of Oconee County got the ball rolling, and rather quickly. Nations said they gathered a committee of local dentists who offered to help. The Oconee Medical Center, understanding the problem, offered to provide space for the clinic, Nations said.

Galloway said recently that a program like what is being offered in Horry and Oconee counties is definitely doable in Spartanburg, but when asked what it would take to bring something like it here, he didn't have an answer.

"I don't know," he said. "I don't know how to answer that."

He said Spartanburg has not been on the top of his priority list. There are other places that are much worse off than Spartanburg, he said.

Nations said, for getting a free dental service in Oconee County, it was a matter of the community being very philanthropic and dentists being willing to help.

Whitney, director of St. Luke's Free Medical Clinic, said, in her experience, dentists in Spartanburg are very willing to help. Her dream is to eventually be able to open a free dental clinic, but said it can't be done unless there is a facility for them to work in. She said the clinic doesn't have a problem recruiting medical doctors to help the under-served, so she doesn't think it will be a problem getting dentists on board.

Challenge to dentists

Dr. Duncan Shirley, who is also a member of the Spartanburg Dental Society, said free clinics can pose many challenges to a dentist, even those who are compassionate about volunteering.

He said he sometimes helps out at clinics in neighboring counties and there are only eight or nine patients who show up.

"To be honest, it's going to be hard to find young dentists who are willing to give up their free time to a free clinic where there are stipulations and regulations, lawyers and HIPAA looking over your shoulders. There is so much bureaucracy involved and red tape and hoops to jump through that most of the guys say ‘you know what, it is really not worth it.'"

He said the best way to get dentists involved in a free clinic would be to let them oversee its operations.

"We like being in control," Shirley said.

Health leaders say if more dentists come forward who express interest in a free clinic, funding might follow. Other health leaders say if funding options present itself first, that may motivate dentists who are willing to help to come forward.

"We, as a community, need to come together collectively and work out a model we can all agree on," Romberger said.

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